LI-RADS version 2018 for hepatocellular carcinoma < 1.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging

Hyeon Ji Jang; Sang Hyun Choi; Se Jin Choi; Won-Mook Choi; Jae Ho Byun; Hyung Jin Won; Yong Moon Shin

doi:10.1007/s00330-023-09554-8

LI-RADS version 2018 for hepatocellular carcinoma < 1.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging

Eur Radiol. 2023 Aug;33(8):5792-5800. doi: 10.1007/s00330-023-09554-8. Epub 2023 Apr 5.

Authors

Hyeon Ji Jang¹, Sang Hyun Choi², Se Jin Choi¹, Won-Mook Choi³, Jae Ho Byun¹, Hyung Jin Won¹, Yong Moon Shin¹

Affiliations

¹ Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
² Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea. edwardchoi83@gmail.com.
³ Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.

PMID: 37017700
DOI: 10.1007/s00330-023-09554-8

Abstract

Objectives: We aimed to develop and evaluate a modified Liver Imaging Reporting and Data System (LI-RADS) version 2018 using significant ancillary features for diagnosing hepatocellular carcinoma (HCC) < 1.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging (MRI).

Methods: Patients who underwent preoperative gadoxetate disodium-enhanced MRI for focal solid nodules < 2.0 cm within 1 month of MRI between January 2016 and December 2020 were retrospectively analyzed. Major and ancillary features were compared between HCCs of < 1.0 cm and 1.0-1.9 cm using the chi-square test. Significant ancillary features associated with HCC < 1.0 cm were determined by univariable and multivariable logistic regression analysis. The sensitivity and specificity of LR-5 were compared between LI-RADS v2018 and our modified LI-RADS (applying the significant ancillary feature) using generalized estimating equations.

Results: Of 796 included nodules, 248 were < 1.0 cm and 548 were 1.0-1.9 cm. HCC < 1.0 cm less frequently showed an enhancing capsule (7.1% vs. 31.1%, p < .001) and threshold growth (0% vs. 8.3%, p = .007) than HCC of 1.0-1.9 cm. Restricted diffusion was the only ancillary feature significant for diagnosing HCC < 1.0 cm (adjusted odds ratio = 11.50, p < .001). In the diagnosis of HCC, our modified LI-RADS using restricted diffusion had significantly higher sensitivity than LI-RADS v2018 (61.8% vs. 53.5%, p < .001), with similar specificity (97.3% vs. 97.8%, p = .157).

Conclusion: Restricted diffusion was the only significant independent ancillary feature for diagnosing HCC < 1.0 cm. Our modified LI-RADS using restricted diffusion can improve the sensitivity for HCC < 1.0 cm.

Key points: • The imaging features of hepatocellular carcinoma (HCC) < 1.0 cm differed from those of HCC of 1.0-1.9 cm. • Restricted diffusion was the only significant independent ancillary feature for HCC < 1.0 cm. • Modified Liver Imaging Reporting and Data System (LI-RADS) with the addition of restricted diffusion can improve the sensitivity for HCC < 1.0 cm.

Keywords: Diffusion magnetic resonance imaging; Gadolinium DTPA; Hepatocellular carcinoma; Liver; Magnetic resonance imaging.

MeSH terms

Carcinoma, Hepatocellular* / diagnostic imaging
Contrast Media / pharmacology
Gadolinium DTPA
Humans
Liver Neoplasms* / diagnostic imaging
Magnetic Resonance Imaging / methods
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity

Substances

gadolinium ethoxybenzyl DTPA
Contrast Media
Gadolinium DTPA